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PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEI TAX I.D.II RERMIT M <br /> o►� K� ceA, do qo Cd�3-03 Z. <br /> LECaA LOT NO. BLOCK T��'� <br /> DESC. Lo� �� ��� (.�OS <br /> OWNER ACDRESS �P VHONE <br /> s-l.w�/ � Lw��, �p2s�•�./ y�� 2sz S8�' <br /> TENANTNAME CONTACTNAME PHONE <br /> VAcpn/� S�M Lr9-/l�on�/ <br /> CONTRACTOR �� , J�v ADDRESS LP CONTR.UCENSE• <br /> /�f <br /> PMONE <br /> �/�S - �SL- � �3ZS <br /> PROOOSED USE OF BUILDING Df Building GYMeChenicel Addition MEA�URCE <br /> PERMR ��!:ombinetion �_� Plumbing WORK teration Eleclric <br /> TYPE �..,( Demolition Ll Sign TYPE w Gas <br /> ��S.G(„17C,.,� u Sprinkler Repair/Meint. OMar <br /> CONTRACT PRICE OF WORK � �/ �Q •Oi CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 7J <br /> WORK DESCRIPTION ' � � �y� Ia S/'1 <br /> /Zc-w•�e. f�-�- � 6-�, • �c �o (`c�e..��ie«-/� t ���,�.¢� <br /> �����1 �✓ ~�- � � �� 'JW -l� -rI✓� � <br /> "-5 N �ucl�o� Y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF 17XTURE OR REM NO. TYPE OF fl7(TURE OR ITEM <br /> WATER CLOSET A/C—A/FiANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER ,Z UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> CISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> T CLOTHES WASHER METAL FIREPLACE/STOVE <br /> � URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHHUST FAN <br /> OTHER UTHER <br /> 1 HEREB'/CERITIFf THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE S�ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF W WS AND ORIDINACES GOVERNING TNIS TVPE OF WORN WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PPESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUl'HORIZED BY THE <br /> OWNER OF TNIS PFiOPERTY TO PcRFORM THE WORK FOR WHICH APPIICATION IS MA�E ANO I COMPLY WITH THE STATE <br /> CONTRQCTORS LAW 1�.27 RCW AND 296.200 WAC. — <br /> �y n`� �.{ i,�,... �l�� l�� <br /> /I.IR <br /> Sfgnalure of Own r/ConirectodAulhonzed.4gent ate <br />